Orientation to Medical Needs Shelters

1. Orientation to Medical Needs Shelters ARRTC 2007

2. Objectives • Provide an overview of how “Responds to disasters when called to duty” applies to all ADPH employees. • Discuss the roles and responsibilities of several disciplines as they relate to shelters during an emergency response. • Discuss some real-life experiences of staff who have worked in Medical Needs Shelters.

3. WHY? • We are the appropriate agency to provide this service. It is a “natural fit”. • It is the right thing to do for the citizens of Alabama. • In 2004, only Jefferson and Mobile counties opened “special needs” shelters. • After Hurricane Ivan, renamed this shelter concept to “medical needs” shelter to better describe the services provided. • During Hurricane Dennis, seven medical needs shelters were opened throughout the state. • ADPH employees staffed these shelters.

4. How Does This Affect Me? • As part of ADPH, we are called to serve and respond to the public’s health needs. • As part of the new mission of public health, part of that response includes disasters, both natural and man-made. • ADPH focuses on shelter response, both mass care and medical needs shelters.

5. What is a Medical Needs Shelter? • A secure facility with power, water, sanitation, limited food service and medical oversight. • A refuge of last resort during emergency conditions for: • persons with physical and /or mental conditions requiring limited medical/nursing oversight who cannot be accommodated in a general population shelter and • who bring their own caregiver, medical supplies, equipment, and special dietary supplies for a 10 day period.

6. Criteria for Opening a Medical Needs Shelter • A weather disaster which would threaten citizens in locales within the state is within 24 hours of occurring. • An evacuation order has been issued. • A widespread power grid failure occurs and is not expected to be restored for two or more days.

7. Criteria for Opening a Medical Needs Shelter • A WMD or natural event occurs that damages the infrastructure. • The State Health Officer orders the opening of medical needs shelters following consultation with the local health officer/administrator and the state and local EMA.

8. Who Will Be Seeking Care in the Medical Needs Shelter? • People with minor health/medical conditions who require professional observation, assessment, and maintenance but who do not require institutional care. • Examples -- People who take medications and/or have vital signs monitored and who are unable to complete these tasks without assistance, and/or people who require oxygen therapy.

9. Who Will Be Seeking Care in theMedical Needs Shelter? • People with chronic stable conditions who may require assistance with the activities of daily living but who do not require institutional care. • Examples --Ostomy patients.

10. Who Will Be Seeking Care in theMedical Needs Shelter? • People with contagious health conditions that require precautions or isolation and who cannot be cared for in a general/public shelter environment. • Examples – a wound care patient and/or someone with a fever/cold.

11. Examples of Equipment & Supplies People May Bring to the Shelter • Cane • Crutches • Dialysis supplies • Feeding pump and supplies (tubing, formula) • Foley catheter and bags • Incontinent products (chucks, diapers, skin care products) • Insulin syringes, medication, glucometers • Nebulizer • Ostomy products • Oxygen and supplies (O2 tubing, portable tanks) • Sleep apnea products C-Pap, Bi-pap • Walkers • Wheel chair

12. Area and Central Office Response Teams • A team which can be deployed quickly to any area of the state as directed by the ADPH Incident Commander. • These teams will consist of: • Nurses • Service Workers • Environmentalists • Support Staff

13. Area and Central Office Response Teams • Teams may be deployed for up to seven (7) days. • Teams could be deployed for any of the following types of events: hurricanes, tornadoes, ice storms, floods, acts of terrorism and disease outbreaks. • Teams based in the affected area(s) will conduct normal emergency response duties, which may include supporting mass care shelters.

14. Area and Central Office Response Teams • Central Office Response Teams will be the 1st Public Health staff to medically manage the Medical Needs Shelters, with response teams from unaffected Public Health Areas deployed as needed. • Teams will respond on short notice and must be ready and on-call 24 hours a day, especially in times of severe weather or suspected outbreak of a disease.

15. Area Response Teams • Teams may work in a challenging environment. • Teams must bring their own personal clothing and comfort supplies to operate for up to seven days. • Teams will bring their clinical, clerical, environmental and social work response kits along with their personal belongings to the staging location, which will normally be the RSA Tower.

16. Area Response Teams • Staging serves the following purposes: • Verify the number and qualifications of team members. • Issue and check equipment (including necessary forms). • Assign transportation. • Issue any additional supplies (water, food, refrigerators, etc.). • Make safety and security decisions. • Finalize any other preparations.

17. Suggested Items for Personal Response Kits • Appropriate Professional License • Department Identification • Appropriate clothing • Weather appropriate clothing • Walking shorts are acceptable • Scrub suits are acceptable for appropriate staff • Athletic Shoes recommended • Flashlight with additional batteries • Sleeping bag, pillow, blanket • Personal hygiene items including medications • Waist Pack in lieu of purse

18. PUBLIC HEALTH STAFF RESPONSE • ADPH staff will respond appropriately to disasters at the direction of the State Health Officer. • Examples – mass care shelters, medical needs shelters, etc…

19. PROCEDURES FOR NURSE RESPONSE • Staff could be notified to respond to shelters in one of several ways, depending upon the nature of the incident: • Through Area Administrator or designee • Through ADPH ICS • Through ADPH Duty Officer or immediate supervisor

20. NOTIFICATION • Notification will include: • Nature of assignment • Where to report • When to report • Duration of assignment • What to bring

21. PROCEDURES FOR STAFF RESPONSE • Staff should be prepared to remain in a shelter for up to 7 days and follow the shelter shift schedule. • Shifts are expected to be no more than 12 hours. • The staff will remain in the shelter until released by the Nurse Manager.

22. NURSE IN CHARGE • The Nurse Manager reports to the Area Nursing Director or designee. • At least one Nurse in Charge will be available per shift in each medical needs shelter. • The Nurse Manager will oversee the medical aspects of the medical needs shelter.

23. NURSE MANAGER • The Nurse Manager must be familiar with the building; its size, facilities, layout and supplies available. • The Nurse Manager will oversee selection of treatment areas, disbursement of supplies, and provision of information to the EOC. • The Nurse Manager will assign/supervise all staff related to the medical management of the shelter.

24. NURSE IN CHARGE • The Nurse Manager will supervise the triage/assessment of all individuals presenting to the medical needs shelter to determine their most appropriate placement. • The Nurse Manager will ensure all shelterees are discharged appropriately.

25. NURSE IN CHARGE • The Nurse Manager will assure collection of medical data pertaining to shelterees. • The Nurse Manager will assist in recovery of medical equipment and supplies. • The Nurse Manager may perform other medical-related duties as needed.

26. CHARGE NURSE • One Charge Nurse will be appointed for each shift. • Charge Nurse will supervise dispersing supplies to patient care areas. • Assess and triage persons presenting with medical needs. • Assign patients and provide direct supervision of staff.

27. CHARGE NURSE • Ensure that procedures performed by staff are in compliance with protocol and physician orders • Monitor condition of patients and transfer patients as needed to skilled nursing facilities or other locations • Assure that supplies are properly utilized and supplies inventoried

28. CHARGE NURSE • Conduct a shift report at the end of each shift • Assure continuity of care until the patient is discharged from the shelter • Assist in the return of durable medical equipment • Assist in collection and packaging of nondurable medical supplies for storage

29. STAFF NURSE • The Staff Nurse will report to the Charge Nurse. • The Staff Nurse will deliver appropriate nursing services within the medical needs shelter under the direction of the Charge Nurse. • The Staff Nurse will assist the Charge Nurse.

30. STAFF NURSE • The Staff Nurse will perform triage/nursing assessment on individuals presenting at the medical needs shelter. • The Staff Nurse will refer individuals who do not meet the medical needs criteria to the mass care shelter or other facility with assistance from the service worker. • The Staff Nurse will assess the physical condition of the shelterees on an on-going basis.

31. STAFF NURSE • The Staff Nurse will assist caregiver in delivering services to shelterees. • The Staff Nurse will assist with the discharge process. • The Staff Nurse will assist with the collection of medical data pertaining to shelterees.

32. CARE ASSISTANTS • Assist with disbursement of medical supplies to patient care areas • Provide assistive care for patients and families • Assist patient with completion of shelter forms • Light housekeeping duties

33. Service Worker • Most importantly - Be Flexible! • The Service Worker will assist nurses with intake applications and assess clients as they register. • The Service Worker will begin disaster counseling planning for anyone with no discharge plans. • The Service Worker will provide resource referrals.

34. EMERGENCY MEDICAL TECHNICIAN • Assist Charge Nurse as needed • Assist in triage assessment • Assist in the on-going assessment of patients • Assist patients with ADLs • Assist in emergency situations, to level of licensure, following established protocols

35. Service Worker • The Service Worker will provide age-appropriate activities for children. • The Service Worker will provide referrals for clients with mental illness, mental retardation or substance abuse issues. • The Service Worker will interact with shelter clients to continually assess their situation.

36. SOCIAL WORKER IN CHARGE • Reports to the Charge Nurse • Ensure that service worker kits arrive at shelter • Identify children’s area for activities • Work with Nurse Manger to assign service workers to shifts • Assist with intake applications

37. SOCIAL WORKER IN CHARGE • Complete psychosocial intake form • Begin discharge planning at admission • Provide resource referrals • Interact with patients and caregivers to continually assess their situation • Provide referrals to those with mental illness/mental retardation/substance abuse issues

38. SOCIAL WORKER IN CHARGE • Ensure that all patients are discharged properly • Ensure that Service Worker Kits are collected and returned to Public Health

39. Service Worker • The Service Worker will observe clients for signs of stress and difficult emotions (grief, anxiety, etc). • The Service Worker will observe staff for signs of stress and fatigue and offer water, food or a break. • The Service Worker will provide stress management techniques for clients and staff who may need them. • The Service Worker will assist in the shelter as needed.

40. Support Staff • The Support Staff will assist clients in completing forms. • The Support Staff will perform data entry as needed and will maintain registration records. • The Support Staff will assist with set up and breakdown of the shelter. • The Support Staff will assist nursing and other personnel as needed. • The Support Staff will report any problems to the Nurse in Charge.

41. SAFETY OFFICER • Assist with staging of food service insuring that food is properly managed and stored (Under the supervision of an environmentalist assigned to the shelter or a local environmentalist who will be making regular visits to the shelter). • Work with Facility Manager and Nurse Manager to determine shelter layout • Ensure that proper width aisles are maintained • Ensure that all aisles and entrance/exit points are free of obstructions

42. SAFETY OFFICER • Maintain knowledge of safety and emergency equipment • Ensure that proper waste disposal receptacles are in place • Monitor waste disposal to ensure the safety and cleanliness of the facility • Periodically walk through the shelter to check on status of patients, families, and staff.

43. TEAM SUPPORT OFFICER • Work with the Nurse Manager and Facility manager to determine staff break and rest areas • Set up staff rest and break areas • Monitor staff personal needs and meet those needs as appropriate • Maintain charged batteries in cell phones, radios, and other equipment

44. TEAM SUPPORT OFFICER • Maintain high fuel levels in vehicles and equipment • Run errands and/or pick up items from pharmacies and other supply stores • Assist as needed in general shelter responsibilities • Check through ICS for road conditions and fuel availability for return trip

45. PARTNER AGENCIES AND RESPONSIBILITIES

46. PARTNER AGENCIES AND RESPONSIBILITIES

47. Summary • Emergency response has become a fundamental part of our mission. • We are committed to preparing staff as quickly as possible for these new roles and responsibilities.